SARS‐CoV‐2 seroprevalence and implications for population immunity: Evidence from two Health and Demographic Surveillance System sites in Kenya, February–December 2022

Abstract

AbstractBackgroundWe sought to estimate SARS‐CoV‐2 antibody seroprevalence within representative samples of the Kenyan population during the third year of the COVID‐19 pandemic and the second year of COVID‐19 vaccine use.MethodsWe conducted cross‐sectional serosurveys among randomly selected, age‐stratified samples of Health and Demographic Surveillance System (HDSS) residents in Kilifi and Nairobi. Anti‐spike (anti‐S) immunoglobulin G (IgG) serostatus was measured using a validated in‐house ELISA and antibody concentrations estimated with reference to the WHO International Standard for anti‐SARS‐CoV‐2 immunoglobulin.ResultsHDSS residents were sampled in February–June 2022 (Kilifi HDSSN = 852; Nairobi Urban HDSSN = 851) and in August–December 2022 (N = 850 for both sites). Population‐weighted coverage for ≥1 doses of COVID‐19 vaccine were 11.1% (9.1–13.2%) among Kilifi HDSS residents by November 2022 and 34.2% (30.7–37.6%) among Nairobi Urban HDSS residents by December 2022.Population‐weighted anti‐S IgG seroprevalence among Kilifi HDSS residents increased from 69.1% (65.8–72.3%) by May 2022 to 77.4% (74.4–80.2%) by November 2022. Within the Nairobi Urban HDSS, seroprevalence by June 2022 was 88.5% (86.1–90.6%), comparable with seroprevalence by December 2022 (92.2%; 90.2–93.9%). For both surveys, seroprevalence was significantly lower among Kilifi HDSS residents than among Nairobi Urban HDSS residents, as were antibody concentrations (p < 0.001).ConclusionMore than 70% of Kilifi residents and 90% of Nairobi residents were seropositive for anti‐S IgG by the end of 2022. There is a potential immunity gap in rural Kenya; implementation of interventions to improve COVID‐19 vaccine uptake among sub‐groups at increased risk of severe COVID‐19 in rural settings is recommended.